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In parts of Chile and northern India gallbladder cancer is common enough that a cheap ultrasound programme aimed at the highest-risk people might catch it while surgery can still cure it. Nobody has run the trial.
Sixty percent of Tata Memorial's 1,950 gallbladder cancer patients arrived with metastases and only 16 percent could be treated for cure; median survival was 58.2 months for early-stage against 4.2 months for metastatic disease. Risk is concentrated by geography (the Gangetic belt; southern Chile), ancestry (Mapuche), sex, gallstones and typhoid carriage, which makes a targeted rather than population programme plausible. Ultrasound is cheap and available. The risks are overdiagnosis of polyps and over-treatment of stones, which the Kaiser Permanente cohort shows are real in low-incidence settings; a high-incidence setting changes the arithmetic and only a randomised or cluster trial can show whether deaths fall.
The clearest statement of where the burden falls and why late presentation, not drug choice, decides most outcomes in high-incidence regions; it is also the home of the POLCAGB trial.
The best single starting point for a clinician or researcher new to the disease, written by the groups running the Chilean and Indian cohorts; its list of unmet needs is the skeleton of the ideas section on this page.
The largest natural history study of gallbladder polyps undermines the surveillance half of the 2022 European guideline: small polyps grow as a matter of course and almost never become cancer, while size at first scan carries most of the risk.
The Indian epidemiology matters to the NHS: people of South Asian heritage make up a large part of several English cities, and Asian ethnicity is a named risk factor in the European polyp guideline.
Shares Gallbladder polyp (polypoid lesion), Overdiagnosis, Ultrasound, Screening and the tag gallbladder-evidence.
Shares Gallbladder polyp (polypoid lesion), Overdiagnosis, Ultrasound, Gallbladder cancer and the tag gallbladder-evidence.
Shares Gallbladder polyp (polypoid lesion), Ultrasound, Screening, Gallbladder cancer and the tag gallbladder-evidence.
Shares Prophylactic (preventive) cholecystectomy, Screening, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Most of the world has almost no cancer care and the tag gallbladder-evidence.
Shares Prophylactic (preventive) cholecystectomy, Screening, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Prophylactic (preventive) cholecystectomy, Screening, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Prophylactic (preventive) cholecystectomy, Screening, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
Shares Prophylactic (preventive) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.